Duties & Responsibilities:

• Responsible for expanding and improving medical records acquisition for RADV risk adjustment program

• Manages relationships and effectively communicate with internal and external partners regarding quality objectives and targets as they relate to CMS audits.

• Collaborates with key departments on Quality driven initiatives championing process improvement

• Analyzes data to identify data-driven opportunities for improvement and determine root causes in areas that need improvement to be successful in our CMS audits.

• Ensures a working relationship on internal group projects for process improvements.

• Analyzes data to identify trends, issues, and opportunities for performance improvement as it relates to clinical quality

• Prepares quality improvement related presentations that accurately summarize complex information, details and data

• Assists other departments with clinical documentation and coding initiatives

• Provides reporting and summaries on CMS audits in areas, but not limited to, noticeable trends, medical records, and issues.

• Ensures accuracy and completeness of medical records and complying with HIPAA guidelines.

• Analyzes invoice data to reduce billing errors and ensure billable info is correct for the Clinical Documentation and Coding Department audits.

• Additional duties as necessary and as directed

Minimum Qualifications:

• HS Diploma or GED from an accredited institution

• 2-3 years in medical record retrieval in a health plan/ provider setting or administrative experience in lieu of health care setting

• Strong writing, time management, critical/creative thinking, communication, and problem-solving skills.

• Strong working knowledge of Microsoft Office Suite and Outlook

Preferred Qualifications:

• Associates degree or higher from an accredited institution

• Prior experience in Managed Care/Health Insurance, in a health-related field or environment

• Background in health care or managed care. This can include work experience and/or education.

• Experience with a health plan's quality improvement/management department

• Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc.).

• Understanding of CMS RADV requirements and medical record documentation best practices

Compliance & Regulatory Responsibilities: Ensures all work is compliant with relevant regulatory guidelines.

License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960

• All Other Locations (within approved locations): $42,200 - $62,400

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.